Stress, family coping and adjustment in adolescents with juvenile rheumatoid arthritis (JRA).
Item
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Title
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Stress, family coping and adjustment in adolescents with juvenile rheumatoid arthritis (JRA).
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Identifier
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AAI9969687
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identifier
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9969687
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Creator
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Degotardi, Pamela Bubolo.
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Contributor
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Adviser: Tracey A. Revenson
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Date
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2000
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Language
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English
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Publisher
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City University of New York.
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Subject
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Psychology, Developmental | Psychology, Clinical | Psychology, Social | Health Sciences, Rehabilitation and Therapy
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Abstract
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This study examined how family-level coping affects adjustment for families who have an adolescent with juvenile rheumatoid arthritis (JRA). Drawing from family systems theory and a developmental perspective, I proposed a multivariate model of how disease severity, family demographics, and perceived stress influence adjustment outcomes. Family coping and developmental stage were posed as moderators of this relationship.;Following a routine clinic visit the families of 35 early adolescents (10--13 years), and 33 late adolescents (14--19 years) with JRA were interviewed using a semi-structured protocol. The interview explored family narratives of disease onset, response to JRA-specific stressors, and adaptation across several domains (school, peer group). Interviews were coded for endorsement of 22 family-level coping strategies, using the FCCS (Hauser et. al., 1993), and reduced through factor analysis to five scales: Team Effort, Status Quo, Emotion Processing, Cognitive Flexibility, Seeking Meaning. Following the interview, parents and adolescents completed separate self-report measures of stress and adjustment.;Overall, parents reported significantly more stress than their children. Parents reported concerns regarding their child's future, whereas, adolescents focused on immediate concerns, e.g., pain, activity restrictions. Adolescents' (but not parents') reports of JRA-specific stress were strongly related to concrete indicators of disease severity (pain, functional limitations). Stress was also associated with poorer adherence, increased internalizing, lower quality of life, and greater parental depression.;Families used many coping strategies (M = 12). Disease severity, stress and family coping were good predictors of most adjustment outcomes, explaining between 44% (internalizing) and 82% (quality of life) of the variance. Moreover, coping moderated the relationship between disease severity and adjustment: Although stress was inversely related to adjustment, at levels of high stress family coping acted as a stress-buffer. In particular, family use of the strategies of team effort or seeking meaning was related to improved quality of life, and efforts to maintain the status quo were related to improved adherence.;Surprisingly, there were few differences between early and late adolescents, and no interactions between the child's age and length of time since diagnosis on any measures. This study demonstrated the utility of a structured family interview for assessing family-level coping and highlighted the primacy of cognitive appraisals of the illness experience in the psychosocial adjustment of adolescents with JRA.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
